Self-expanding stents in transjugular intrahepatic portosystemic shunt: experience with nitinol Strecker stents

The aim of our study was to evaluate the performance and efficacy of a new self-expanding stent (nitinol Strecker stent) in the transjugular intrahepatic portosystemic shunt (TIPS) procedure. We have successfully placed 64 nitinol Strecker stents in 48 patients. The average portosystemic gradient decreased from 22 to 11 mm Hg. Balloon dilatation was necessary in 12 of 35 angiographically controlled cases at 5 days (34%), because of incomplete stent expansion, small thrombi within the stent or obstruction. At 1–6 months stent malfunctions occurred in 8 of 23 patients who underwent control angiography (34%) and at 6–24 months in 6 of 7 patients (85%). Rebleeding occurred in 2 of 39 patients (follow-up > 1 month) (5%) and temporary crises of de novo encephalopathy were observed in 11 of 48 patients (23%). Refractory ascites completely resolved in 4 of 6 patients (66%) and improved in the remaining 2 cases. Compared with other self-expanding stents, nitinol Strecker stents seem to be equally effective in TIPS; no increase in complication rate was observed, either clinical or stent-related. Correspondence to: P. Rossi     

冠脉内支架术治疗复杂型冠脉病变

目的 探讨经皮冠状动脉内支架置入术治疗复杂型冠状动脉病变的疗效。方法 对8例19支复杂型冠状动脉血管病交行球囊预扩张后，植入25枚支架，其中前降支9枚，回旋支6枚，右冠脉10枚。结果 术后经冠脉造影证实狭窄消失，血流TIMI Ⅲ级，支架置入的成功率100％，1例出现穿刺部位出血，无其他并发症，随诊1～18个月，1例术后2个月再发心绞痛。结论 冠脉内支架术治疗复杂型冠状动脉病变是一种完全有效的介入治疗技术，其成功率高，临床疗效好，并发症少。     

食管支架术后局部组织中相关炎性细胞的变化分析

目的 研究食管支架术后不同时间局部食管组织中炎性细胞浸润及分布的变化,以及与再狭窄形成的关系。方法 采用免疫组化（ＡＢＣ法）检测支架术后１、２、４、８周组织中ＣＤ３、ＣＤ１９、ＣＤ６８的表达状况,从而反映出巨噬细胞（ＭΦ）、Ｔ－淋巴细胞（Ｔ－ＬＣ）、Ｂ－淋巴细胞（Ｂ－ＬＣ）的浸润及分布状况。制备再狭窄组织的细胞悬液,采用流式细胞分析法检测组织中３种细胞的含量变化。采用特殊染色法分析组织中肥大细胞（     

Firebird冠脉涂膜支架系统生物学安全性评价研究

依据国家标准GB/T16175-1996,选择10项试验对Firebird冠脉涂膜支架系统进行生物学安全性评价[1],结果表明该支架系统的血液相容性良好,无全身毒性和细胞毒性,无热源性、致敏性、刺激性,也无遗传毒性,组织相容性尚可,是一种生物相容性优良的Firebird冠脉涂膜支架系统.     

泪囊黏液囊肿的鼻泪管支架植入治疗观察

目的 评价鼻湘管支架植入术在治疗泪囊黏肿中的应用价值。方法 对21例（21眼）泪囊黏滚囊肿患者行鼻泪管支架植入术，逆行扩张鼻泪道后植入特制的鼻泪管支架，术前术后行数字减影泪道造影检查，分析其疗效。结果 21眼均成功植入鼻泪管支架，手术成功率为100%，术后随访2—43个月，有效率为100%。无严重并发症的发生。结论 鼻泪管支架植入术治疗泪囊黏液囊肿操作简便，具有良好的临床效果，值得推广。     

Histological findings after angioplasty using conventional balloon, radiofrequency thermal balloon, and stent for experimental aortic coarctation

Abstract Background : Use of balloon angioplasty or stent implantation has been reported to be effective in relieving coarctation of the aorta. However, restenosis frequently occurs after balloon angioplasty for native aortic coarctation in small infants, and sometimes develops after stent implantation because of vessel growth. The causes of restenosis remain uncertain. The purpose of this study was to assess the histologic differences in vascular responses to angioplasty using conventional balloon, radiofrequency thermal balloon (RFTB), or stent for experimental aortic coarctation. Methods : The authors surgically created an aortic coarctation model using 14 puppies. Angioplasty using conventional balloon, RFTB, or stent was performed 1 month after the initial operation. At the acute or chronic phase after angioplasty, the animals were killed and histologic studies were performed. Results : More vascular injuries were noted in the specimens from animals undergoing conventional angioplasty than in those with RFTB or stent. However, neointimal hyperplasia was seen more often after RFTB or stent because of the proliferation of smooth muscle cells from the tunica media, caused by secretion of growth factors. Apoptosis reached a peak 1?2 weeks after angioplasty, regardless of the type of intervention. Conclusions : The authors conclude that angioplasty with RFTB or stent can provide relatively small injuries in the vessel wall for aortic coarctation, but care must be taken to prevent restenosis caused by intimal hyperplasia, because neointima hyperplasia is more frequent after RFTB or stent.     

丹参片在冠状动脉支架介入治疗后应用的初步观察

目的观察丹参片与抗血小板药物联合应用对冠状动脉支架介入治疗后血栓等术后冠状动脉事件的预防作用。方法选择支架植入成功的冠心病患者82例,随机分为治疗组(42例)和对照组(40例),两组均服用支架植入术常规用抗血小板药,治疗组加用丹参片,每次4片,每日3次。采用双缩尿法、激光散射比浊法和流式细胞术检测两组患者行支架植入术前、术后即刻和术后30 d时的血浆纤维蛋白原(Fg)、C反应蛋白(CRP) 和血小板膜糖蛋白((3P)Ⅱb／Ⅲa、P选择素(CD62P)的变化。结果与对照组比较,治疗组血浆CRP显著下降 (P<0．05),GPⅡb／Ⅲa和CD62P也有降低的趋势。经6个月临床随访,治疗组心绞痛复发5例(11．9%),未发生支架术后再狭窄;对照组心绞痛复发21例(52．5％),支架术后再狭窄9例,心肌梗死3例;治疗组心绞痛复发率显著低于对照组(P<0．05)。结论丹参片与抗血小板药联合应用能预防冠状动脉支架血栓等术后冠状动脉事件,且疗效优于单用抗血小板药。     

双J管在上尿路疾病中的应用

目的探讨双J管在上尿路疾病中的临床应用效果。方法治疗81例不同原因的上尿路疾病患者,采用双J管内引流及支架。结果除1例双J管未插入膀胱外,80例均获得了内引流及支架的满意效果。结论上尿路疾病的各种开放性手术,最好选双J管内引流及支架,肾盂内较大结石行ESWL前经尿道膀胱镜置入双J管。     

Tracheoesophageal fistula: New option in management

Tracheoesophageal fistula is a life threatening condition. Patients not managed surgically ultimately die of their disease. Surgical management is the treatment of choice. We present a case of a patient that developed a tracheoesophageal fistula after tracheostomy. Surgical repair was done which failed due to infection. The patient was managed with the help of an esophageal stent and Trichloroacetic Acid cautery. This approach can be used in selected patients, depending upon the size and site of TEE Larger fistulae and those situated lower down e.g. supra carinal cannot be managed by this technique.     

扩张置管治疗癌性复杂性食管狭窄和瘘的近远期疗效观察

目的应用带膜金属支架治疗癌性难治性食管狭窄和瘘,并对近、远期疗效进行观察。方法在电子内镜下应用扩张器和支架置入器,对临床确诊的难治性食管狭窄和(或)瘘的48例患者进行支架置入术。根据病情的不同情况选择不同的治疗方式。结果48例患者共放置支架64个,置管后狭窄处直径由(4.02±1.35)mm增至(15.05±4.02)mm(P<0.01),吞咽困难由3.28±0.42级改善为0.94±0.73级(P<0.01),食管瘘患者瘘口全部闭合。随访1个月及1年有效率分别为100%、74.2%,1年失访共3例,复发共8例经重复治疗缓解。结论内镜直视扩张置管治疗难治性食管狭窄和瘘,操作直观简便,定位准确,成功率较高,近远期效果较好。